Kipp Benjamin R, Stadheim Linda M, Halling Shari A, Pochron Nicole L, Harmsen Scott, Nagorney David M, Sebo Thomas J, Therneau Terry M, Gores Gregory J, de Groen Piet C, Baron Todd H, Levy Michael J, Halling Kevin C, Roberts Lewis R
Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA.
Am J Gastroenterol. 2004 Sep;99(9):1675-81. doi: 10.1111/j.1572-0241.2004.30281.x.
The aim of this study was to assess the relative sensitivities and specificities of fluorescence in situ hybridization (FISH) and routine cytology for the detection of malignancy in biliary tract strictures.
Bile duct brushing and aspirate specimens were collected from 131 patients being evaluated for possible malignant bile duct strictures. Both specimen types were assessed by FISH but only brushing specimens were assessed by cytology. The FISH assay used a mixture of fluorescently-labeled probes to the centromeres of chromosomes 3, 7, and 17 and chromosomal band 9p21 (Vysis UroVysion) to identify cells having chromosomal abnormalities. A case was considered positive for malignancy if five or more cells exhibited polysomy.
Sixty-six of the 131 patients had surgical pathologic and/or clinical evidence of malignancy. Thirty-nine patients had cholangiocarcinoma, 19 had pancreatic carcinoma, and 8 had other types of malignancy. The sensitivity of cytology and FISH for the detection of malignancy in bile duct brushing specimens in these patients was 15% and 34% (p < 0.01), respectively. The sensitivity of FISH for the bile aspirate specimens was 23%, and the combined sensitivity of FISH for aspirate and brushing specimens was 35%. The specificity of FISH and cytology brushings were 91% and 98% (p= 0.06), respectively.
FISH is significantly more sensitive than and nearly as specific as conventional cytology for the detection of malignant biliary strictures in biliary brushing specimens. FISH may improve the clinical management of patients who are being evaluated for malignancy in bile duct strictures.
本研究旨在评估荧光原位杂交（FISH）和常规细胞学检查在检测胆管狭窄恶性病变方面的相对敏感性和特异性。
从131名因可能存在恶性胆管狭窄而接受评估的患者中收集胆管刷检和抽吸标本。两种标本类型均通过FISH进行评估，但仅刷检标本通过细胞学检查进行评估。FISH检测使用了针对染色体3、7和17着丝粒以及染色体带9p21的荧光标记探针混合物（Vysis UroVysion）来识别具有染色体异常的细胞。如果五个或更多细胞显示多倍体，则该病例被认为恶性病变呈阳性。
131名患者中有66名具有手术病理和/或临床恶性病变证据。39名患者患有胆管癌，19名患有胰腺癌，8名患有其他类型的恶性肿瘤。在这些患者的胆管刷检标本中，细胞学检查和FISH检测恶性病变的敏感性分别为15%和34%（p < 0.01）。FISH对胆汁抽吸标本的敏感性为23%，FISH对抽吸和刷检标本的联合敏感性为35%。FISH和细胞学刷检的特异性分别为91%和98%（p = 0.06）。
在胆管刷检标本中检测恶性胆管狭窄时，FISH比传统细胞学检查显著更敏感，且特异性相近。FISH可能会改善对因胆管狭窄恶性病变接受评估的患者的临床管理。
